“When a person is admitted to the hospital, we send flowers and cards,” said Paul Ippel, executive director of Network 180, Kent County’s public mental health and substance abuse resource agency. “There was a time people wouldn’t say the word cancer and now we talk (openly) about going for cancer treatment, but we’re reluctant to say we’ve been admitted to a psychiatric hospital.”

Mental health and challenges to treatment gained attention this month following the Tuscon shooting that left six dead and uncovered tales of erratic behavior by accused gunman Jared Loughner. Even though Loughner was not diagnosed, experts say the incident presents a “teachable moment.”

“We have not finished processing the experience ... but it’s clear that we need to make sure we double our efforts to make sure our crisis intervention system is accessible to people who need them,” said Michael Head, deputy director for Michigan’s Mental Health and Substance Abuse Administration.

A community concern

Mental illness causes disturbances in thinking, feeling and coping, and it comes in all forms. It includes serious conditions such as schizophrenia, bipolar disorder and severe depression as well as anxiety, obsessive compulsive and personality disorders.

A GROWING NEED

Michigan’s public mental health system saw a 26 percent increase in total people served between budget years 2003 and 2009. More than 25,000 people in Kent County are served annually. Statewide numbers over the years:

Left untreated, mental illness can cause severe distress, including paranoia and despair. Sufferers often have trouble maintaining relationships, and therefore a connection to society. They may self-medicate with alcohol and drugs.

They also are more prone to homelessness, job loss, and suicidal thoughts.

Often, dealing with the illnesses means overcoming a stigma deeply rooted in the mistaken belief that sufferers can overcome their problems all by themselves. And all too often, experts say, people believe that individuals with the most serious disorders are beyond help, a danger to themselves and others.

“It’s only a tiny minority that have anything to do with the Tucsons and Virginia Techs; those are really exceptional type of situations,” said Dr. James Dillon, director of psychiatric medical services for the state’s mental health administration. “There’s a dozen homicides every day, and very few of them are committed by people with mental illness.”

James Dillon

In fact, Dillon and other experts point to American Psychiatric Association studies, relying on figures from the U.S. Bureau of Justice Statistics, showing people with severe mental illness are often no more prone to violent behavior than others.

They are, however, much more likely — 11 times more likely, according to a 2005 study —to be the victims of violent crime.

Paying attention

While overcoming stigma is key to dealing with mental illness, the experts stress it is important to recognize and acknowledge its symptoms. They can vary in severity, but sudden changes in behavior, social withdrawal and unusual thoughts or expressions are clear warning signs.

“We’re looking for significant changes,” Ippel said.

Ippel said while it’s not uncommon for a person to suffer emotional distress following such events as death in the family, divorce or job loss, it is a concern if the symptoms are prolonged.

Michael Fusillo

“We would expect that to happen for a period of time. If that lasted for three months, we wouldn’t be surprised,” he said. “If it’s going on a year or five years later, we would be concerned.”

If someone is exhibiting problems, the professionals say, try to find out what is going on. Everyone has a bad day, but sustained hopelessness or hostility mean they may need help. Above all, make sure they know you care.

CHANGING OUR MINDS

A Press exploration of mental illness

Amid all the talk about health care, mental illness barely rises to a whisper. And yet, in violence or silent suffering, it often is a matter of life and death.

In a yearlong occasional series, The Press plans to challenge stigmas and myths, bringing into focus people and their problems — and hope for those who suffer. To see complete coverage of the series click here.

We are committed to providing tools for readers to deal with their own or loved ones’ problems. And to telling your stories. To share, e-mail us at localnews@grpress.com. Address mailed-in stories to the attention of Kyla King and Sue Thoms, The Grand Rapids Press, 155 Michigan St. NW, Grand Rapids, MI 49503.

Today, we give you an overview of issues here and beyond. In March, we will look at a chronic problem for the mentally ill and their families: housing.

“If it’s not a good one, you shouldn’t be the one to talk to them,” he said. “You should get someone who had a good relationship and get them talk to them.”

To avert a crisis, seek help through a family doctor, an employee hot line, a public agency or and advocacy group.

He said treatment and support give an estimated 70 percent to 90 percent of patients significant reduction of symptoms and improved quality of life.

What about extreme cases, where the fear is real that people might harm themselves and others?

Anyone can go to the police or public mental health agency and make a statement. Professionals will document the case and take the request to a judge, who will rule on whether an individual needs to be hospitalized, involuntarily or not.

“Most people that we end up seeing who need services do so voluntarily,” Ippel said. “About 40 percent of individuals that we end up hospitalizing are involuntary.”

A challenged system

Michigan mental health leaders say they must keep finding creative ways to serve the growing population of individuals with mental illnesses, as state funding has remained flat for a decade.

That’s especially important for an increasing group of individuals without health insurance who need help but do not have a severe mental illness and make too much money to qualify for Medicaid.

“If someone is depressed because they lost their job or because of marital problems, they probably won’t be seen in community mental health,” Dillon said, “unless that person become suicidal.”

People being seen in the public system increased 26 percent from 2003 to 2009, said deputy director Head. Meanwhile, flat funding from 2004 to 2009 translated into a reduction of more than $70 million.

That has meant transforming the way the agency does business, Head said. For example, the state recently hired, trained and deployed more than 750 “peer-support specialists” — individuals who have experienced hospitalization, homelessness and incarceration yet learned to manage severe mental illness.

“Often it’s somebody that’s been down that route of having their life fall apart and put back together,” Head said. “They’re able to relate to that person and speak more directly to the kinds of feelings and experiences.”

Another big challenge is medication — getting it to those that need it, and finding a way to pay for it.

Experts said many of the most severe conditions are treated with expensive psychotropic drugs that are limited by Medicaid or private insurance.

“Insurance companies are becoming increasingly restrictive in what you can prescribe,” Pine Rest’s Fusillo said. “When we have a patient, part of the decision on what medication to try is what are they going to be able to take when they leave, because if it’s something they can’t afford then they’re not going to take it.”

Beyond affordability, it’s often a challenge to make sure patients continue to take their meds, Ippel said, because of unwanted side effects.

Those can depend on the type of drug and can be long-term. They include dizziness, drowsiness, muscle spasms or stiffness, loss of coordination, weight gain and sleep disturbance.

The symptom of denial also can disrupt the regime of medication — patients may have a hard time believing it will help, or that it is helping, Ippel said.

“If a person begins to feel better, then they believe they can manage without the medication,” he said.

Moving forward

Despite challenges, most experts say with continued support from individuals and lawmakers, we can make progress on mental health issues.

”This is an opportunity,” Ippel said. “But this needs to be a community effort. We need to place as much importance on this as we do health care reform.”

CHANGE YOUR MIND ABOUT MENTAL HEALTH
Mental health is closely linked to and is as important as physical health. Problems are real and deserve to be treated. It’s no one’s fault or a sign of weakness or something you can ”snap out of.” It’s OK for males and females to seek help. There’s hope. People recover with treatment and enjoy happy, healthy lives.

What to look for:Social withdrawal - lost of interest in hobbies, pleasurable activitiesDepression - little or no pleasure in life, low energy, change in eating or sleeping patterns, feelings of worthlessness or extreme guilt, crying a lot for no reasonUnusual behavior- severe anxiety, panic, or fear, big mood swings, too much energy, trouble concentrating or following through, easily irritated or angry, racing thoughts or agitation, rapid weight loss, drug or alcohol abuse, unusual sensitivity to light and clothingThought disorders - hearing voices, seeing images that other people do not, believing others are plotting against you, wanting to harm yourself or someone else.Inappropriate expression of feelings - sudden hostility, indifference in highly important situations, inability to cry, express joy, or laughter

What to do to avert a crisis:
Reach out to people you trust.
Engage the person if they trust you, or find someone they do trust.
Get professional help through a family doctor, employee assistance hot line, local mental health agency, or mental health advocacy group.
If the person is in danger of hurting themselves or others contact local police or a local public mental health agency.